Liver, core or wedge biopsy
=Introduction= Liver core biopsies can be performed for medical reasons (e.g. evaluate cirrhosis in a patient with known HCV) or to obtain a diagnosis on a liver mass. If a biopsy is done during transplant harvest to look for steatosis prior to transplant, frozen section will be requested. =Grossing in= Core biopsy #Specimens are received in saline or formalin. #Dictate length, diameter, color and number of cores. #Submit wrapped in paper (not between sponges which introduce artifact). #Most institutions will preorder specific number of levels and special stains (e.g., trichrome, reticulin, PAS, iron) Liver wedge biopsy Occasionally done intraoperatively, when surgeon observes an unexpected lesion. In these cases a frozen section will be performed. Describe the measurements of the specimen, ink the cauterized surface, and serially section to reveal the lesion. Describe it and freeze the lesion with surrounding normal parenchyma. =Review and Signout= If it is a native liver, they are usually asking to grade the involvement of the liver in Hepatitis C, but there might be other processes such as steatosis, steatohepatitis, vascular injury, etc. If it is a transplant liver, then they are often asking for Hepatitis C activity and acute cellular rejection or other rejection. Transplant liver biopsies can have ductopenic rejection, centrivenular rejection, and a variety of other findings. Native liver biopsies get stains automatically. Transplant liver biopsies do not, unless you order them separately. Print out the previous diagnoses and pull the last biopsy for comparison. Sample diagnostic lines Hepatitis #Liver, biopsy: :Chronic hepatitis, (in-, minimally, mildly, moderately, severely) active, consistent with viral hepatitis C with (mild periportal fibrosis, septae formation, bridging fibrosis, cirrhosis), see note. :NOTE: The biopsy has _ portal tracts available for review. The portal tracts contain a _ (e.g., mild) inflammatory infiltrate composed of _ with _ degree of interface activity. There is _ (e.g., minimal) lobular activity _ (with/without) apoptotic hepatocytes. There is _ (e.g., mild) zone _ steatosis. The trichrome and reticulin stains support the above diagnosis. The iron stain shows _ (e.g., grade 1) intrahepatocellular hemosiderin and _ (e.g., moderate) hemosiderin accumulation in Kupffer cells. The PAS stain shows _ (e.g., no) intrahepatocellular PAS-positive globules and _ (e.g., no) Kupffer cell hyperplasia. Non-hepatitis NOTE: The biopsy has _ portal tracts available for review. The biopsy shows _. The trichrome and reticulin stains support the above diagnosis. The iron stain shows _ (i.e. grade 1) intrahepatocellular hemosiderin and _ (i.e. moderate) hemosiderin accumulation in Kupffer cells. The PAS stain shows _ (i.e. no) intrahepatocellular PAS-positive globules and _ (i.e. no) Kupffer cell hyperplasia. Transplant liver #Liver, biopsy: :Chronic hepatitis, (in-, minimally, mildly, moderately, severely) active, consistent with viral hepatitis C with (mild periportal fibrosis, septae formation, bridging fibrosis, cirrhosis). :No evidence of acute cellular or chronic rejection, see note. :NOTE: The biopsy has _ portal tracts available for review. The portal tracts contain a _ (e.g., mild) inflammatory infiltrate composed of _ with _ degree of interface activity. There is _ (e.g., minimal) lobular activity _ (with/without) apoptotic hepatocytes. There is _ (e.g., mild) zone _ steatosis. The trichrome and reticulin stains support the above diagnosis. The iron stain shows _ (e.g., grade 1) intrahepatocellular hemosiderin and _ (e.g., moderate) hemosiderin accumulation in Kupffer cells. The PAS stain shows _ (e.g., no) intrahepatocellular PAS-positive globules and _ (e.g., no) Kupffer cell hyperplasia. Comment if there is any significant change in the level of rejection or fibrosis since the last biopsy. ---- Return to Gastrointestinal Grossing